Avoidable deaths and superbug infections among hospital issues

A DAMNING performance report examining the failings at the Royal Bolton Hospital has been revealed to the public for the first time.

Individual directors have been held to account for the failings, which include increases in avoidable deaths, superbug infections, elderly patients falling and hospital acquired infections.

Other areas of concern include a shortage of midwives, cancelled operations, delayed transfers of care, increased staff sickness and a poor uptake of mandatory training.

Directors on Bolton NHS Foundation Trust’s board presented exception reports, which detailed why certain areas in the hospital were failing, to the first Trust board meeting to be held in public.

The Trust’s new interim chairman, David Wakefield, made the decision to start holding meetings in public to add more transparency to the Trust and asked the directors to create reports for the problem areas.

Mr Wakefield was appointed by the health watchdog Monitor in August, after the Trust was put into “red risk” for financial failings, It came five months after Monitor slammed the board’s governance in March, when it was first placed under “red risk” for meeting A&E and 18-week healthcare targets.

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Since he was appointed, Mr Wakefield has made changes to the board. He appointed Wendy Hull as interim finance director to replace Gary Raphael, who left by mutual agreement, and has appointed Terry Watson as a turnaround director as part of a £1 million turnaround plan with Deloittes.

The Trust remains in “red risk” and the lowest rating of one out of five, and at the meeting, Trust secretary Esther Steele said Monitor would be confirming at its next meeting that the Trust would be unlikely to achieve a three rating for the next 12 months.

Chief nurse and director of patient safety and experience Dee Sissons told the meeting the hospital did not have enough midwives per birth to meet national requirements and the financial situation was the only thing stopping them from recruiting more midwives. She said: “They have a different way of staffing their wards but there is no evidence that the services are unsafe.”

But Mr Wakefield said he did not want to wait until a mother had a bad experience or there was a problem with the department and asked the board to review the matter.

A report, from Jez Tozer, chief operations officer, detailed how cancelled operations were causing the hospital to miss targets, which could lead to financial penalties and even the intervention of Monitor for failing 18-week targets.

Ten of the 25 operations cancelled in August were due to failed machinery, which had not been properly maintained and cost £400,000 to replace.

A separate report, brought by Ms Sissons, revealed out of 11 best care indicators, only one — hand hygiene — was marked as green, two were amber and the remaining eight — including dementia care, falls assessment, food and nutrition and record keeping — were failing to meet their targets and marked as red.

Report highlights problems

The Royal Bolton Hospital does not have enough midwives, half its staff have not completed mandatory training and hundreds of elderly patients have been injured falling on wards.
A performance report, revealed at the hospital’s first ever board meeting to be held in public, showed the areas where the hospital is failing to meet targets.
Out of 60 different indicators for targets including A&E performance, cancer treatment, maternity services and superbug infections, nine were revealed to be failing overall this year.
The report, which included statutory targets, those set by health watchdog Monitor and some chosen by the hospital, coloured them red, for those it has failed, amber, for those that have improved but are off plan, and green for those doing well.
So far this financial year, 27 of the targets are green, 11 amber and nine red. The others have not been classified.
In August, 23 were green, 13 amber and seven red.
Here is a breakdown of some of the indicators.

A&E - Green

Accident and Emergency was heavily criticised in March by health watchdog Monitor for failing to achieve four-hour waiting time targets.
The national A&E target states 95 per cent of people should be admitted, treated and discharged within four hours.
The department has met its target each month from April and won a £225,000 performance award from Bolton Clinical Commissioning Group in September for its performance.
Bolton CCG has invested £800,000 into the A&E department, which included funding for a Clinical Decisions Unit.
The department has recently won two staff awards.

Referral times - Green

Referral time within 18 weeks was criticised by Monitor in March for failing targets.
Figures revealed at the time, showed in the financial year 2011/12, more than 2,500 patients waited more than 18 weeks and one in 20 patients, almost 900, had to wait nearly six months for treatment.
The national target is for 90 per cent of patients to be treated within 18 weeks.
Since April, the target has been met overall each month, but the hospital is still failing to meet it in certain specialisms, including orthopaedic care, oral surgery, and cardothoracic surgery.

Maternity - Red

The hospital does not have enough midwives per birth.
The expected national midwife to baby standard is 1:28. In Bolton it is 1:31.
The hospital is delivering 6,500 babies each year but only has enough midwives to deliver 6,300.
They currently have a shortage and are recruiting for midwives to take them up to the level for 6,300.
Staff are currently moved around the unit to flex the fluctuating workload.
Delivery is prioritised and one-to-one, but this is sometimes to the detriment of other areas.

Staff sickness - Red

The Trust is failing to meet its staff sickness target by 1.05 per cent.
So far this year, it has lost 4.80 per cent of days lo due to sickness. This figure dropped to 4.29 per cent in August.
The areas with the worst sickness records include Acute Adult Care, Elective Care, Family and Corporate.
Hotspots in August included the children’s nursing team, staff working with complex healthcare cases staff on ward C4 and F4 and ultrasound.
In August, 22 per cent of nurse bank hours were used to cover staff sickness.

Falls - Red

The hospital is failing its targets for falls for patients over 75 years of age so far this year and could get fined £22,000.
There have been 261 falls since April against a target of 214. The figure is lower than the number of falls in 2011/12, but the hospital is failing to achieve its target of reducing the number of falls by 30 per cent.
Since February 2012, 20 falls have resulted in moderate or severe harm, which includes a fractured hip, shoulder and pelvis, lacerations and fractures to wrists and fingers.
Staff feel they are understaffed.

Cancelled operations - Red

In August, the Trust failed its target for cancelled operations.
There were 25 cancelled operations in August. Ten of these were due to the failure of the endoscopy washers, which cost £400,000 to replace.
Of those cancelled, two were because patients had been sent the wrong starving instructions, three were cancelled due to overbooking, three after admin errors and one after an x-ray machine failed.
The cancellations could affect 18-week referral to treatment performance, which could lead to financial penalties at the end of the year.

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Mandatory training - Red

Almost half of staff have not completed mandatory training. The figure across the Trust for August is 53.8 per cent.
It is 45.98 per cent in the Acute Adult Care Division, 53.44 per cent in Family Division and 59.24 per cent in Nursing Patient Safety and Experience.
Between April and June, 66 per cent of 880 places were taken for core mandatory training sessions.
Staff are not accessing online training — the uptake is between 50 and 24 per cent.
If this target is failed there will be a financial penalty in March.

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Comments (14)

My husband had an operation and came home with a terrible bacterial infection, he went back into hospital as his temp was really high and his heart rate also. He was taken back to Orthopedics where he had the op around 1am. They put him in a bed and left him until lunch time the next day before they gave him a drink. They did nothing else and sent him home that same day. My husband had to go to his GP where the GP treated him for the bacterial infection in his stomach. Months later my husband still isn't right.

My husband had an operation and came home with a terrible bacterial infection, he went back into hospital as his temp was really high and his heart rate also. He was taken back to Orthopedics where he had the op around 1am. They put him in a bed and left him until lunch time the next day before they gave him a drink. They did nothing else and sent him home that same day. My husband had to go to his GP where the GP treated him for the bacterial infection in his stomach. Months later my husband still isn't right.leonpowsneymyarse

My husband had an operation and came home with a terrible bacterial infection, he went back into hospital as his temp was really high and his heart rate also. He was taken back to Orthopedics where he had the op around 1am. They put him in a bed and left him until lunch time the next day before they gave him a drink. They did nothing else and sent him home that same day. My husband had to go to his GP where the GP treated him for the bacterial infection in his stomach. Months later my husband still isn't right.

Score: 4

leonpowsneymyarse says...10:14am Tue 9 Oct 12

Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.

Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.leonpowsneymyarse

Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.

Score: 0

Bendix says...11:59am Tue 9 Oct 12

this hospital is a disgrace: bad management is the key issue made worse by shockingly poor governance. When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?

this hospital is a disgrace: bad management is the key issue made worse by shockingly poor governance. When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?Bendix

this hospital is a disgrace: bad management is the key issue made worse by shockingly poor governance. When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?

Score: 5

duffbikes says...1:29pm Tue 9 Oct 12

'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.

'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.duffbikes

'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.

Score: 4

Bendix says...3:04pm Tue 9 Oct 12

Indeed it should.

Indeed it should.Bendix

Indeed it should.

Score: 0

Holiday Queen says...4:14pm Tue 9 Oct 12

leonpowsneymyarse wrote…

Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.

Because obviously all operations are performed on wards aren't they???? I have never heard anything as stupid in my life, I have no doubt some procedure may have been going on, but an operation??

[quote][p][bold]leonpowsneymyarse[/bold] wrote:
Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.[/p][/quote]Because obviously all operations are performed on wards aren't they???? I have never heard anything as stupid in my life, I have no doubt some procedure may have been going on, but an operation??Holiday Queen

leonpowsneymyarse wrote…

Not to mention when my husband had his op, he was taken into theater where he witnessed two patients separated by a curtain being operated on at the same time. It was disgusting.

Because obviously all operations are performed on wards aren't they???? I have never heard anything as stupid in my life, I have no doubt some procedure may have been going on, but an operation??

Score: 4

davedog says...7:55pm Tue 9 Oct 12

Bolton A and E is an absolute disgrace! Saying that it is not helped by the scum that plague the doors on Friday/Saturday nights! I have experienced staff treating 'drunks' and 'drug addicts' before babies/toddlers who have real injuries and illnesses! They are clearly under staffed and I'm not surprised they haven't met their targets! Doctors and nurses seem to work incredibly hard but cannot cope with the demand. My wife recently received fantastic care when recovering from an operation and stayed on E3 ward. When visiting her it was like walking into a mental asylum with some patients clearly in need of specialist psychiatric treatment. It seems management are directing their resources into the wrong areas and this situation needs immediate attention. Let's hope they can sort it out and bring about improvements soon!

Bolton A and E is an absolute disgrace! Saying that it is not helped by the scum that plague the doors on Friday/Saturday nights! I have experienced staff treating 'drunks' and 'drug addicts' before babies/toddlers who have real injuries and illnesses! They are clearly under staffed and I'm not surprised they haven't met their targets! Doctors and nurses seem to work incredibly hard but cannot cope with the demand. My wife recently received fantastic care when recovering from an operation and stayed on E3 ward. When visiting her it was like walking into a mental asylum with some patients clearly in need of specialist psychiatric treatment. It seems management are directing their resources into the wrong areas and this situation needs immediate attention. Let's hope they can sort it out and bring about improvements soon!davedog

Bolton A and E is an absolute disgrace! Saying that it is not helped by the scum that plague the doors on Friday/Saturday nights! I have experienced staff treating 'drunks' and 'drug addicts' before babies/toddlers who have real injuries and illnesses! They are clearly under staffed and I'm not surprised they haven't met their targets! Doctors and nurses seem to work incredibly hard but cannot cope with the demand. My wife recently received fantastic care when recovering from an operation and stayed on E3 ward. When visiting her it was like walking into a mental asylum with some patients clearly in need of specialist psychiatric treatment. It seems management are directing their resources into the wrong areas and this situation needs immediate attention. Let's hope they can sort it out and bring about improvements soon!

Score: 5

Angelrose25 says...10:54pm Tue 9 Oct 12

This hospital is an absalutey disgrace and an ebarrassment. I recently took my new born baby to A & E as he was extremely poorly and constantly screaming. Me and my partner arrived at A & E at 9pm and at 2am we still hadn't been seen however, 2 teenagers who decided they would go out and drug themselves up on all sorts then start screaming abuse at everyone in the waiting area and fighting were the 1st ones to be seen and rushed to be sorted. An absalute joke!! How perfetic worthless junkies get higher priority than seriously ill patients and expecially innocent children! Absalutley disgusted.

This hospital is an absalutey disgrace and an ebarrassment. I recently took my new born baby to A & E as he was extremely poorly and constantly screaming. Me and my partner arrived at A & E at 9pm and at 2am we still hadn't been seen however, 2 teenagers who decided they would go out and drug themselves up on all sorts then start screaming abuse at everyone in the waiting area and fighting were the 1st ones to be seen and rushed to be sorted. An absalute joke!! How perfetic worthless junkies get higher priority than seriously ill patients and expecially innocent children! Absalutley disgusted.Angelrose25

This hospital is an absalutey disgrace and an ebarrassment. I recently took my new born baby to A & E as he was extremely poorly and constantly screaming. Me and my partner arrived at A & E at 9pm and at 2am we still hadn't been seen however, 2 teenagers who decided they would go out and drug themselves up on all sorts then start screaming abuse at everyone in the waiting area and fighting were the 1st ones to be seen and rushed to be sorted. An absalute joke!! How perfetic worthless junkies get higher priority than seriously ill patients and expecially innocent children! Absalutley disgusted.

Score: 3

macauley says...11:17pm Tue 9 Oct 12

all bad comments on here.everone cant be wrong.

all bad comments on here.everone cant be wrong.macauley

all bad comments on here.everone cant be wrong.

Score: 2

kingofthekippax says...11:30pm Tue 9 Oct 12

I was referred to the orthopaedic dept. on 5 seperate occasions by my G.P as I had severe swelling on my knee.Each time I went I saw a different "specialist" and on each occasion was told there was nothing wrong with me,on my fifth visit I was even told that my temperature of 106 and my nightsweats were not connected in any way with my knee.I decided that instead of going home I would attend A+E at Salford Royal Hospital.After seeing the triage nurse I was x-rayed,blood samples were taken and I was referred to their orthopaedic dept.who admitted me to the hospital immediately and put on a course of intranevenous antibiotics for 5 days to treat the septic arthritis in my knee joint that was slowly poisoning me.

I was referred to the orthopaedic dept. on 5 seperate occasions by my G.P as I had severe swelling on my knee.Each time I went I saw a different "specialist" and on each occasion was told there was nothing wrong with me,on my fifth visit I was even told that my temperature of 106 and my nightsweats were not connected in any way with my knee.I decided that instead of going home I would attend A+E at Salford Royal Hospital.After seeing the triage nurse I was x-rayed,blood samples were taken and I was referred to their orthopaedic dept.who admitted me to the hospital immediately and put on a course of intranevenous antibiotics for 5 days to treat the septic arthritis in my knee joint that was slowly poisoning me.kingofthekippax

I was referred to the orthopaedic dept. on 5 seperate occasions by my G.P as I had severe swelling on my knee.Each time I went I saw a different "specialist" and on each occasion was told there was nothing wrong with me,on my fifth visit I was even told that my temperature of 106 and my nightsweats were not connected in any way with my knee.I decided that instead of going home I would attend A+E at Salford Royal Hospital.After seeing the triage nurse I was x-rayed,blood samples were taken and I was referred to their orthopaedic dept.who admitted me to the hospital immediately and put on a course of intranevenous antibiotics for 5 days to treat the septic arthritis in my knee joint that was slowly poisoning me.

Score: 1

macauley says...12:44am Wed 10 Oct 12

i had two new hips done there.on follow up told they were fine despite pain and bad limp.went to another hospital to be told one needed to be re-done afteronly two years.what faith can you have at that place?.

i had two new hips done there.on follow up told they were fine despite pain and bad limp.went to another hospital to be told one needed to be re-done afteronly two years.what faith can you have at that place?.macauley

i had two new hips done there.on follow up told they were fine despite pain and bad limp.went to another hospital to be told one needed to be re-done afteronly two years.what faith can you have at that place?.

Score: 0

collthorn says...8:48am Wed 10 Oct 12

duffbikes wrote…

'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.

I completely agree, when Ten of the 25 operations cancelled in August were due to failed machinery, which had not been properly maintained and cost £400,000 to replace, and Almost half of staff have not completed mandatory training. Surely the missing money or mismanaged funds could have financed this. But in the managements favor, they did however get a glowing green, for the hand hygiene situation. Perhaps Mrs Smith who hasn't had her life changing operation yet, after waiting 6 months, will feel really reassured that at least we all have clean hands. Seems like fur coat and nothing else underneath. If that sum of money went missing from the Post Office, wouldn't the police be called in

[quote][p][bold]duffbikes[/bold] wrote:
'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.[/p][/quote]I completely agree, when Ten of the 25 operations cancelled in August were due to failed machinery, which had not been properly maintained and cost £400,000 to replace, and Almost half of staff have not completed mandatory training. Surely the missing money or mismanaged funds could have financed this. But in the managements favor, they did however get a glowing green, for the hand hygiene situation. Perhaps Mrs Smith who hasn't had her life changing operation yet, after waiting 6 months, will feel really reassured that at least we all have clean hands. Seems like fur coat and nothing else underneath. If that sum of money went missing from the Post Office, wouldn't the police be called incollthorn

duffbikes wrote…

'When are the ex-chairman and his non-executive colleagues on the board going to be called to account and banned from any similar offices?' Surely that should read, 'any office'.

I completely agree, when Ten of the 25 operations cancelled in August were due to failed machinery, which had not been properly maintained and cost £400,000 to replace, and Almost half of staff have not completed mandatory training. Surely the missing money or mismanaged funds could have financed this. But in the managements favor, they did however get a glowing green, for the hand hygiene situation. Perhaps Mrs Smith who hasn't had her life changing operation yet, after waiting 6 months, will feel really reassured that at least we all have clean hands. Seems like fur coat and nothing else underneath. If that sum of money went missing from the Post Office, wouldn't the police be called in

Score: 1

tigerlilly1 says...5:50pm Thu 11 Oct 12

Yet more negativity related to The Royal Bolton Hospital. No one seems to care that staff on some of these wards work entire shifts some days without lunch breaks because there just isn't enough staff to provide care for patients while they are on lunch breaks and with no money in the pot for extra staff it isn't going to improve any time soon. People in general need to look at the the big picture, Bolton is very lucky to still have a district general hospital when you think the government is closing district general hospital in favour of super centers. So ask yourself this people of Bolton would you all rather it closed down and you all had to travel to Salford, Manchester, Liverpool and other areas to visit relatives and for treatment on themselves? I have been in a position twice where I've had to dash to Bolton General Hospital to be with relatives who were dying, the thought of not being able to get there because my relative is in another hospital really upsets me and I know it has its faults because the staff are run ragged day in and day out and money is short so equipment isn't that great but it's there and it's local so how about we hear some nice things for a change before the government chose to close it down!

Yet more negativity related to The Royal Bolton Hospital. No one seems to care that staff on some of these wards work entire shifts some days without lunch breaks because there just isn't enough staff to provide care for patients while they are on lunch breaks and with no money in the pot for extra staff it isn't going to improve any time soon.
People in general need to look at the the big picture, Bolton is very lucky to still have a district general hospital when you think the government is closing district general hospital in favour of super centers.
So ask yourself this people of Bolton would you all rather it closed down and you all had to travel to Salford, Manchester, Liverpool and other areas to visit relatives and for treatment on themselves?
I have been in a position twice where I've had to dash to Bolton General Hospital to be with relatives who were dying, the thought of not being able to get there because my relative is in another hospital really upsets me and I know it has its faults because the staff are run ragged day in and day out and money is short so equipment isn't that great but it's there and it's local so how about we hear some nice things for a change before the government chose to close it down!tigerlilly1

Yet more negativity related to The Royal Bolton Hospital. No one seems to care that staff on some of these wards work entire shifts some days without lunch breaks because there just isn't enough staff to provide care for patients while they are on lunch breaks and with no money in the pot for extra staff it isn't going to improve any time soon. People in general need to look at the the big picture, Bolton is very lucky to still have a district general hospital when you think the government is closing district general hospital in favour of super centers. So ask yourself this people of Bolton would you all rather it closed down and you all had to travel to Salford, Manchester, Liverpool and other areas to visit relatives and for treatment on themselves? I have been in a position twice where I've had to dash to Bolton General Hospital to be with relatives who were dying, the thought of not being able to get there because my relative is in another hospital really upsets me and I know it has its faults because the staff are run ragged day in and day out and money is short so equipment isn't that great but it's there and it's local so how about we hear some nice things for a change before the government chose to close it down!

Score: 4

Chris Custodiet says...10:37am Fri 12 Oct 12

Was it really Mr Wakefield that decided that meetings should be held in public or was it someone above him who had been told to weald a big stick? The NHS Foundation Trust Regulator, Monitor, used to be about as effective as a dead sheep but changes have been made and it has now been instrumental in the removal of the Chairs of 17 NHS Foundation Trusts.

Was it really Mr Wakefield that decided that meetings should be held in public or was it someone above him who had been told to weald a big stick? The NHS Foundation Trust Regulator, Monitor, used to be about as effective as a dead sheep but changes have been made and it has now been instrumental in the removal of the Chairs of 17 NHS Foundation Trusts.Chris Custodiet

Was it really Mr Wakefield that decided that meetings should be held in public or was it someone above him who had been told to weald a big stick? The NHS Foundation Trust Regulator, Monitor, used to be about as effective as a dead sheep but changes have been made and it has now been instrumental in the removal of the Chairs of 17 NHS Foundation Trusts.

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